Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran.

BACKGROUND: Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens. OBJECTIVES: The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014. METHODS: In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used. RESULTS: Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR). CONCLUSIONS: We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.

Deep vein thrombosis as a rare complication of brucellosis.

BACKGROUND: Brucellosis can involve almost any organ system and may present with a broad spectrum of clinical presentations. In this study, we present a case of deep vein thrombosis due to human brucellosis. CASE PRESENTATION: A 15- year old boy presented with acute pain and swelling in his left thigh in June 2011, when he complained of fever, chills and lower extremity pain in which he could barely walk. In family history, his older brother had brucellosis 3 weeks ago and appropriate medication was given. The tubal standard agglutination test (wright test) and 2ME test were positive (in a titer of 1/1280 and 1/640, respectively). Peripheral venous doppler ultrasound of left lower extremity showed that common iliac, femoral, external iliac, superficial and deep femoral vein and popliteal vein were enlarged and contained with echogenous clot. He was treated with rifampicin 600 mg once a day, doxycycline 100 mg twice a day (both for three months) and amikacin 500 mg twice a day (for 2 weeks) accompanied with anti-coagulant. Ten days after the onset of this treatment, thrombophlebitis was cured. The follow up of the patient showed no abnormality after approximately one year later. CONCLUSION: In brucellosis endemic areas, the clinicians who encounter patients with deep vein thrombosis and current history of a febrile illness, should consider the likelihood of brucellosis.

Epidemiological, clinical and laboratory features of patients hospitalized with 2009 pandemic influenza in north of Iran.

BACKGROUND: The clinical manifestations and outcome of influenza infection differ between various patients in the world. The purpose of this study was to assess the clinical manifestations of patients with confirmed or suspected novel H1N1 flu infection in Sari, North of Iran. METHODS: From September 2009 to January 2010, the patients' data were collected by retrospective chart review of medical records. Laboratory confirmation included a positive RT-PCR (reverse transcriptase-polymerase-chain-reaction assay) from a nasal or pharyngeal swab sample. RESULTS: Nearly 80% of established patients were in age group of 15-45 years. Approximately 14.6% of female cases were pregnant There was no significant difference in clinical and laboratory characteristics of patients with confirmed H1N1 virus infection to total cases with Influenza Like Illness (ILI). Thirty nine (95.1%) of the established patients had a combination of fever plus sore throat or cough. Relative lymphopenia was reported in 36.6%. Pneumonia was the most common complication. Acute pericarditis evolved in one case and aseptic meningitis was reported in another. CONCLUSION: Precise collecting information of clinical manifestations, risk factors and other characteristics of flu, can help to the early infection detection, timely treatment of patients and proper preventive measurements.

Fulminant myopericarditis in an immunocompetent adult due to pandemic 2009 (H1N1) influenza A virus infection.

Acute myopericarditis is a well-recognized but rare complication of numerous viral infections. Here we report a case of fulminant myopericarditis presenting with acute heart failure and a state of shock in a previously healthy young woman. H1N1 influenza A virus sequences were identified in throat and pericardial fluid, suggesting a viral source of the infection.

An unusual complication of a common endemic disease: clinical and laboratory aspects of patients with brucella epididymoorchitis in the north of Iran.

BACKGROUND: Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. METHODS: In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. FINDINGS: Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. CONCLUSIONS: In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.